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Prurigo Nodularis Follow-up

  • Author: Daniel J Hogan, MD; Chief Editor: William D James, MD  more...
 
Updated: Aug 13, 2015
 

Further Outpatient Care

Monitor patients with prurigo nodularis for the following:

  • Signs of improvement
  • Resistance to treatment
  • Development of symptoms or signs of underlying medical or psychiatric conditions
  • Atypical lesions meriting skin biopsy
  • Use of alternative therapies that may actually worsen atopic dermatoses
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Complications

Some healed lesions show pigmentary changes and scarring.

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Prognosis

Prurigo nodularis is benign and does not increase mortality; however, severe morbidity can occur in untreated and even in some treated persons who are affected. Pruritus and the extent of body surface area involved become so great for some patients that they no longer feel functional for work or other everyday activities.

Some conditions associated with prurigo nodularis may cause mortality. Prurigo nodularis has been documented to be much more common in immunocompromised and HIV populations. The positive predictive value (PPV) for HIV positivity was 36% for prurigo nodularis in a study from French Guiana. The PPV for having a CD4 lymphocyte count of less than 200/mcL was 72% for prurigo nodularis. Prurigo nodularis was thus predictive of advanced immunosuppression, and, in the absence of facilities to perform a CD4 count, this study suggests that HIV antiretrovirals should be initiated for patients with prurigo nodularis in third world countries.[41]

Some cases of prurigo nodularis are associated with internal malignancy. Hodgkin disease (lymphoma) may present with pruritus and lichenified nodules.[42] Prurigo nodularis may be the first manifestation of chronic autoimmune cholestatic hepatitis[43] and may be seen with severely decreased kidney function and uremic pruritus.

The prognosis for spontaneous remission of prurigo nodularis is not good. Once prurigo nodularis lesions occur, complete resolution of lesions is uncommon. Most lesions remain present in some form even after long-term treatment. At this time, treating more than just the most symptomatic lesions is difficult. Considerable time is usually required to slow or stop the itch/scratch cycle so that the lesions resolve.

Ultimately, a strong therapeutic alliance is the best outcome predictor because the course of the disease is long, with waxing and waning symptoms, making the patient prone to being subjected to excessive diagnostic procedures and to seek alternative therapies.

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Contributor Information and Disclosures
Author

Daniel J Hogan, MD Clinical Professor of Internal Medicine (Dermatology), Nova Southeastern University College of Osteopathic Medicine; Investigator, Hill Top Research, Florida Research Center

Daniel J Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, Canadian Dermatology Association

Disclosure: Nothing to disclose.

Coauthor(s)

Stephen H Mason, MD 

Stephen H Mason, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery, Women's Dermatologic Society, Skin Cancer Foundation

Disclosure: Nothing to disclose.

Siobahn M Hruby, MD Internal Medicine Physician, Boys Town National Research Hospital

Siobahn M Hruby, MD is a member of the following medical societies: American College of Physicians, American Medical Association

Disclosure: Nothing to disclose.

Sharron M Mason, MD Staff Physician, Department of Internal Medicine, University of Kansas School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD Associate Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Franklin Flowers, MD Department of Dermatology, Professor Emeritus Affiliate Associate Professor of Pathology, University of Florida College of Medicine

Franklin Flowers, MD is a member of the following medical societies: American College of Mohs Surgery

Disclosure: Nothing to disclose.

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Prurigo nodularis. Courtesy of Jeffrey Meffert, MD.
Prurigo nodularis. Courtesy of Jeffrey Meffert, MD.
 
 
 
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